A few mothers are seated with the Health Officer-in-Charge of Sumaila Yamma Primary Healthcare Centre (PHC), who has just finished post-natal counseling. Bilikis, a second-time mother, cannot hide her delight that today she was attended to earlier than usual. She comments that during her first pregnancy, also attended to at this PHC, things were a bit different. “On Wednesdays, there are typically a lot of pregnant women, and it sometimes used to get a little overwhelming for the staff of the PHC,” she said. All through the ante-natal care for her current pregnancy, however, she says the officer-in-charge and other health officers seemed better informed about her medical history and her needs, which in turn made her feel cared for more personally.
The basic health facility in Sumaila Yamma, in Sumaila LGA, Kano State is in a difficult-to-reach community. One devoid of mobile network signal, with a thriving population of over 5,000 residents.
Hajiya Saratu Sali, the Health Officer-in-charge of Summaila Yamma PHC explained why her officers are now able to cut down on the waiting time for their patients. She credits an innovative service brought in over the last year to PHCs like hers in Kano state; a data management and video training platform stored on a tablet that has given her and her officers the ability to record patient’s details electronically as well as have access to mobile training on important health topics. This is the reason mothers like Bilikis are spending less time at the Sumaila Yamma health centre during antenatal days.
For herself, Hajiya Sali says the Video Training (VTR) application on the tablet has allowed her to learn more about infant care and family planning, which she teaches to her patients. The videos on the device are usually tailored to the needs of the particular facility, taking into consideration language and the availability of resources in that community. This allows officers to easily use the device in a language that they are comfortable with and that their patients can also understand.
Hajia Saratu applauded the improvements that the device has brought to her work at Sumaila Yamma PHC. The data management platform is being implemented by Instrat GHS, a Mobile Health Solutions company and this innovation is in the pilot stage in Kano State. Hajiya Saratu’s one complaint is that patient information is still being recorded on both the tablet and book registers, which doubles her work.
The state of data management in Nigeria
Ideally, existing mechanisms for data collation and management are intended to provide adequate information for health planning and decision making. However, in Kano and Nigeria as a whole, existing health information management systems have struggled with providing accurate or variegated data. A recent observation by Professor Isaac Adewole, Honorable Minister for Health, noted that the lack of ‘accurate’ data on people living with HIV/AIDS has encumbered the Federal Government’s efforts to control the spread of the disease in the country.
Kano state is the second most populous state in Nigeria, with a population of 11,058,300. The state government, over the years, has put in place three tertiary healthcare facilities, 39 general hospitals and about 1,200 Primary Healthcare Centres (PHC) to cater for the healthcare of its teeming denizens. The tasks and systems involved in recording, updating, and analyzing data of patients from every hospital and healthcare centre across the state, are intricate.
On a monthly schedule, health records officers at various PHCs make data available to designated Health Management Information System (HMIS) officers at their corresponding local governments. These are done with the aid of registers that have been meticulously filled by the records officer. HMIS officers in LGAs verify for errors or discrepancies and in turn transfer the data to the HMIS unit in the state Ministry of Health’s Department of Planning, Research and Statistics (DPRS). Shafiu Jibrin, the Health records officer for Makoli PHC in Dawakin Kudu LGA, notes that at the end of a typical clinic day he could record as many as 150- 200 patients’ data into the ‘big book’ register at the PHC, and engages the PHC’s Community Health Extension Worker (CHEW) to enable him to get his job done properly.
A simplified run-through of the data flow from Primary Healthcare Centers to decision makers in the state government
Kano state’s health data collection is hinged on a paper-based documentation system which has its perks along with shortcomings. The Director of Medical Services for Kano State, Dr. Saidu Mohammed, cited shortcomings ranging from delay in information, loss of records, fabrication of data, incorrect recording, to inappropriate methods of documentation. He said these issues become magnified when it comes to hard-to-reach PHCs. He admits that there has been intermittent use of digital data collection tools during special state-wide programs, but highlighted that this itself, created a problem of “dispersed” data instead of the needed data integration, owing to inconsistency in the data management techniques used.
An e-application for easier documentation
About an hour-and-a-half drive away from the Kano metropolis is Garfa PHC, also in Sumaila Local Government Area, home to one of the largest onion and potato trading markets in Kano state. In the community’s interior is a PHC facility that is hardly bereft of patients. “They troop in, in their numbers,” Hamisu Aliyu says while gently tapping away at the ‘tablet’ mobile device in his hands. Doubling as the CHEW and the Health Records officer for Garfa PHC, Aliyu is using the Clinic Patients Administration Kit (CLINIPAK) app on the tablet device. Explaining in Hausa, he says he is updating the drug chart for patients attended to at the PHC that day.
CLINIPAK is a mobile application that contains a kit of examination tools necessary to record clinical information about patients. It enables health practitioners to make evidence-based decisions in their facilities which will in-turn impact the lives of their patients positively.
Rukayat Umar Yazeed, Director Northern Operations Instrat GHS, says the CLINIPAK app makes it possible to record a wide range of data ranging from treatment plans, antenatal care, and child spacing to laboratory test results. The information, once entered, is uploaded to a central server which can be accessed by decision-makers in Kano State Ministry of Health via a dashboard.
Satellite Technology: Partnerships for Health Solutions
Abass Muutassim, the Technical Manager for Instrat GHS in the North Zone said Instrat was able to bring this solution to Kano and other states with the help of key partners, including satellite communications (SatComs) provider Inmarsat, and solar energy company Atlantic Waste and Power System (AWPS) Renewable Energy Limited.
The Kano State government played a key role by providing the enabling environment for this system to be implemented. The government also provides human resources in clinical officers, statisticians and healthcare managers who contribute to the adaptability of SatComm, CLINIPAK and VTR applications. These applications are mobile friendly and can be installed on any smart device which makes them usable in areas with existing mobile networks in addition to the satellite communications methods in more remote areas where mobile network has not yet reached.
As laudable as a satellite communication innovation is, one of the major drawbacks of this solution is that it is capital intensive. The estimated cost to install a SatComm unit at a health facility ranges from five to ten million Naira. This does not include the cost required to run and maintain the system. Also, making a shift towards paper-less health data management requires a consistent advocacy drive. Most record officers and statisticians are accustomed to paper documentation and might find it difficult navigating through an application for analysis.
Still, this offers new opportunities in data collection, especially for PHCs in remote areas, where accurate information has always been a challenge for health managers. Kano’s Director of Planning, Research and Statistics, Litti Gwarzo Abdullahi, believes technological innovations in data management will reduce the manpower needed to maintain the system of collecting data, and will help his department meet up with the demand for statistics and data by other stakeholders.
Decisions made after authentic data has been adequately provided and analyzed are the foundation upon which resources are efficiently allocated and utilized in any effective system. According to World Health Organization (WHO), a model Health Information System is one that integrates data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. This is what the health system in Nigeria should strive for, and it begins with an effective means of aggregating data from primary to tertiary levels of care.